Missouri DMH Connections

Community Listening Event on December 18

Department of Mental Health Listening Event

I am so pleased with the Community Listening Event held at the Department of Mental Health building on December 18. I know many of you had attended the listening events in your area before coming all the way to Jefferson City, and I so appreciate that!

I would also like to thank the staff from DMH and Office of Transformation who attended, to learn a bit about the Procovery® program and to help foster community-DMH communications. Focusing on wellness rather than illness is new to most of us in the bureaucracy, as well as joining the types of meetings and events that typify the Procovery program, with staff, family, clients, and community all attending together without “labels” and “levels.”

Those of you from the community did some wonderful modeling at the event. Some Department of Mental Health staff had never been exposed to the Procovery program. You were so friendly and gracious and composed. As the Procovery Liaison working closely with Procovery Institute, I hope to travel to your communities and ask your help (I have much to learn from you) as I put together the policies and some standards to make sure Wellness and the Procovery program are supported and built upon in the right way.

That is why Procovery program’s leveling focus and impact is so important. Meeting together without labels or levels can be hard for some and uncomfortable at first, but I believe it gets easier with repetition and will ultimately be key to meaningful system transformation. Having the constraint of music levels did dampen the spirit somewhat, and I apologize for the sound having to be turned down mid-way through the songs! But with our new CDs we can listen to the Procovery songs ourselves and be reminded of the messages of hope and choice and belief that are so integral to healing as well as systems change. How very exciting to have 3 new Procovery program songs!! They are absolutely fantastic!

Thank you again for taking your time to be part of the Department of Mental Health’s learning experience of the Procovery program. Fostering meaningful dialog with the agencies and people we serve is an exciting aspect of my new role. I look forward to broadening the discussion.

Here’s to all of you and to the Procovery program in Missouri. Happy Holidays!

— Dora Cole, Wellness Director & Procovery Liaison

Thanks and Appreciation in the face of Winter’s Worst!

On behalf of everyone in Central Office, and of leadership at each of the CPS psychiatric facilities, I’d like to thank each and every employee who made it through some very difficult travel conditions to get to work over the past several days.  Your commitment and tenacity, often in face of worry about your homes and family members, ensured that our consumers in our inpatient facilities had access to the treatment and support they need.   Nice job!

Felix Vincenz, Ph.D., Chief Operating Officer, CPS

MRDD Update on Service Coordination and Regional Office Restructure

Recently there have been questions circulating about the direction of the Division, specifically around the provision of service coordination and the regional office restructure.  I would like to take a moment to address both of these important topics with you as we work together to ensure that evidence based best practices are implemented consistently throughout the state to enhance the lives of people with developmental disabilities and their families.

First, I would like to provide context for how we got to where we are.  As you may recall in the spring of 2006, there was a comprehensive regional office system review conducted by 41 reviewers which included self-advocates, parents/family members, community provider agency staff, state quality assurance staff and other DMH staff who made onsite visits to each regional office.  Their final report identified weaknesses in the regional office structure affecting the provision of supports and services and subsequently made recommendations to address caseload sizes, review and revise the quality assurance process, and communication at the local level.

Additionally, in the fall of 2006 the Missouri Mental Health Task Force, after six public hearings, issued a report directing the Division of MRDD to convene a committee of stakeholders to evaluate the feasibility of public/community partnerships to deliver case management services, determine eligibility, manage local wait lists, and provide and/or contract for a system of programs and services in their local areas.  The committee of stakeholders, consistent with the Task Force's recommendation number 24, was comprised of self-advocates, parents, community providers, a Missouri Protection and Advocacy representative, a Missouri Planning Council for Developmental Disabilities representative, and regional office staff.

This fiscal year, the following actions have already been taken to address the issues identified.  The Division received appropriations from the Missouri General Assembly to increase the number of service coordinators available to meet the needs of individuals with developmental disabilities and their families in the regions where caseload ratios are as high as 1:70.  This appropriation funded an additional 40 FTE service coordinators. However, through our partnership with local SB40s, we were able to increase the number of new service coordinators to 53.  We continue to talk with MACDDS and individual SB40 representatives regarding service coordination.  There are currently 25 SB40s that are providing service coordination to 5,000 individuals with developmental disabilities who are consumers of the Division of MRDD.  In some cases, the SB40s have been providing service coordination for nearly 17 years.

Finally, consistent with both reports, we have strengthened the leadership and communication infrastructure at the local level through the hiring of a regional office director at each regional office.

The next step is the regional office restructure being implemented, consistent with state statute, to enhance the local level infrastructure to address recommendations of both reports to ensure the health, safety, and high quality supports and services for individuals with developmental disabilities.  The five components of the regional office under the leadership of the regional office director which will strengthen the Division’s current infrastructure are quality assurance, consumer relations, provider relations, business administration, and clinical.  The quality assurance enhancements will provide the Division with a strengthened ability to monitor, track and trend the quality of supports and services at the local, regional and state levels as well as provide the data and information to the community provider and provider relations staff at the regional office to develop plans and strategies needed for quality improvement and enhancement at each level of the service delivery system.  Additionally, the provider relations section will be responsible for developing, executing, and providing oversight of implementation of all community provider contracts.  All staff are encouraged to review the components and functions of the restructured regional office, which can be found on the Division of MRDD’s website at http://www.dmh.mo.gov/mrdd/mrddindex.htm.

As we move forward with community partnerships with SB40s or Affiliated Community Service Providers (ACSP) to reduce the caseload ratios throughout the state to a standard of 1:40 and the rollout of the restructure of the regional offices, current division employees will have the opportunity to transition into new regional office positions for which they are qualified or to continue to provide service coordination to individuals through the local SB40 or ACSP.

I want to dispel the rumor which has been circulating that when the Division met with the Coalition on November 26^th in Jefferson City it would be issuing an RFP for service coordination.  This is absolutely not true.

The regional office restructure, quality assurance enhancements, decreasing the caseload ratios and the implementation of other contemporary evidence-based best practices will provide a consistency of excellence in service delivery throughout the state which will enhance the quality of outcomes and lives of individuals with developmental disabilities and their families.

– Bernie Simons, Director, Division of MRDD

Rumors Regarding MR Case Managers Unfounded

The department has become aware of some rumors regarding the fate of its case manager positions. The following post is a clarification of the plan for case managers.

Please allow me to clear the confusion that has arisen about the case manager positions in the Division of Mental Retardation and Developmental Disabilities (MRDD). DMH does not plan to eliminate the positions, just to transfer them. The state will continue to pay the cost of the positions, and the people working in those positions are likely to continuing working with their clients, although I suppose it would be possible for an SB 40 Board or an affiliated community service provider (ACSP) to dismiss the person whose reputation is not strong.

All the positions are reimbursed through Medicaid based on their hourly billings on behalf of the clients they serve. They will continue to be reimbursed in the same fashion after the transfer. The unfortunate reality is that, because of the state’s indirect (fringe) costs and the difference in holiday leave policies, a person working for a local entity (SB 40s or ACSPs) can serve consumers more hours, generating more reimbursement through Medicaid, while at the same time costing less. While the differences aren’t huge, they are significant enough that more dollars can be generated for people with developmental disabilities who are not now receiving services.

All of the SB 40 boards or ACSPs where Case Managers would transfer would be Missouri-based either governmental entities or non-profit organizations. We have been providing case management in Boone County (Columbia) and Sedalia for more than 10 years, so we know how well this works and how much extra money can be generated for consumers. A number of other SB 40 Boards have also assumed responsibility for MRDD Case Management across the state. I have also heard rumors that people think we are transferring the positions to for-profit providers. That is untrue.

This transition is the result of the recommendations of the Mental Health Task Force, specifically recommendation 24, and a subsequent committee comprised of leaders, consumers and advocates from the MRDD community statewide.

I have also been told that this is the beginning of a plan to shut down our MRDD Regional Centers. That is also untrue. We are requesting over 100 new state quality-assurance positions in our FY 2009 budget to be placed into our Regional Centers and are restoring a Regional Center Administrator for each Center. A few have been operating without directors.

I know there are lots of rumors out there, and I understand why our state case managers would be anxious about having to transfer, but our job is to make our dollars stretch as far as we can for services for people with developmental disabilities. This transition is about that responsibility.

– Keith Schafer, Director

Another goodbye to a good friend

Dr. John Constantino ended his term on the Mental Health Commission recently, and I want to express our deepest appreciation and admiration for his outstanding leadership as member and chair of the commission for the past three and a-half years. Dr. Constantino’s time on the Commission coincides with some of the most difficult and stressful periods in DMH’s history. Multiyear funding reductions and the gradual erosion of DMH administrative and clinical leadership impacted DMH’s ability to provide critically needed, high-quality mental health services to Missourians. Statewide concerns about the lack of client safety within DMH services, highlighted prominently by the media, further eroded DMH credibility.

Throughout this period, John’s uncompromising leadership as chair of the commission helped overcome organizational paralysis, demanded higher levels of operational and clinical accountability, and helped create a more positive vision for DMH’s future. Under his guidance, the Mental Health Commission conducted a series of well-publicized statewide hearings and issued a critical report entitled “Building A Safer Mental Health System,” highlighting key DMH program safety and treatment problems, and recommending a blueprint for change now being implemented by DMH. While these recommendations necessarily focused on prominent safety issues in DMH programs, they went much farther in mapping a broader direction for improving the overall quality and accountability of DMH services.

Perhaps John’s mental health leadership over the last four years is best depicted in the following quote by Dr. Martin Luther King:

“The ultimate measure of a man is not where he stands in moments of comfort,
but where he stands in times of challenge and controversy.”

On behalf of everyone at the department, we wish John the very best in his numerous endeavors and look forward to a time when our paths will cross again.

Keith Schafer, Director

Mental Health Champions

I have long been very interested in finding a special way to recognize the people that we serve for their many talents and accomplishments. For years I have seen firsthand many inspiring stories of people doing exceptional things, despite having a mental illness, developmental disability, or substance abuse problem. I am very happy to say that we are going to celebrate the accomplishments of these Mental Health Champions.

We are actively soliciting nominations for Mental Health Champions in each of three categories: an individual with a diagnosed mental illness; an individual with a developmental disability; and an individual in recovery from substance or gambling addiction. These individuals should be persons who have overcome their personal challenges to make life better for others and their communities. The Mental Health Champions we select will be persons who inspire others. Nomination information has been distributed to advocacy, provider, and consumer networks. If you wish to learn more, or make a nomination, please go to www.dmh.mo.gov and click on the “News and Events” tab.

– Keith Schafer, Director

Make new friends, but keep the old; one is silver, the other gold – traditional Girl Scout song--author unknown

During the August Mental Health Commission meeting, we experienced the passing of a torch, of sorts, as we said goodbye to George Gladis and welcomed Kathy Carter. Both of these individuals have long and distinguished histories with the department in one form or another, and both are deeply committed to assuring the highest quality possible of the services we offer.

George is a brilliant and tireless strategist, and a master of the legislative process. He established the commission’s first Legislative Committee and made it a priority to find ways to keep lawmakers informed about the issues that affect the people served by DMH across all program divisions. In this regard he is particularly exceptional. DMH has been blessed with a number of outstanding commissioners in its history, but their expertise had generally been focused on a single program area. Not so with George. George’s positive leadership in the political arena has helped DMH achieve increased funding, greater visibility for its consumers, and a higher level of empathy for DMH services among legislators.

Never the “yes man,” George challenged DMH when he thought its policies and practices were getting off track. DMH will miss George, but his legacy will not be lost nor forgotten.

Thanks, George, for your leadership, your commitment, and the standard you have set for future Mental Health Commissioners.

– Keith Schafer, Director

Celebrity Rehab

There has been considerable press about celebrities and politicians popping in and out of pricey rehab programs when they get into trouble. Recent examples are Lindsay Lohan, Britney Spears, Robert Downey Jr., Mel Gibson, Rush Limbaugh, Rep. Patrick Kennedy, and Rep. Mark Foley. Sadly, it has given a black eye to the serious business of substance abuse treatment. According to CBS News:

Rehab has almost become a rite of passage. In fact, some critics complain that removing the stigma has made rehab appear cool. Combine that with spa-like facilities where they cater to Hollywood's pampered and privileged, and one can't help but wonder if rehab really is a doorway to recovery.

Ms. Lohan’s latest stay at the plush “Wonderland” program could have cost as much as $40,000 a month. The Passages program in Malibu costs $67,500 a month. Compare that with the average cost of a treatment episode in one of Missouri’s contracted community programs, which is less than $2,000. The tragedy is that many of the high-priced programs for celebrities are rich with amenities but poor with evidence-based treatment, while our community-based system in Missouri is grossly underfunded but embraces best practices—at least to the extent that meager resources will allow.

— Mark Stringer, Director, Division of Alcohol and Drug Abuse

The Need for Children's Mental Health Services

National studies suggest that as many as 10% of children and youth in the United States have some form of a mental health illness.  Often mental health services for children are not readily available.  In fact, the President’s New Freedom Commission, a national study of the status of mental health services in the country, reported that mental health services for children are fragmented, underfunded, and poorly coordinated.  The Commission’s report called for a redesign of the mental health delivery systems.

Most children spend at least seven hours a day in school.   Children who need mental health services attend school just like all other children.  Several professional groups have suggested that a solution to the fragmented mental health delivery system for children is to build the delivery system in conjunction with schools  - -  a school-based mental health delivery system  - -  that includes funding for  prevention, screening, early identification, early intervention, and mental health interventions.  Missouri has several communities in which the Community Mental Health Center, school districts, and other child-serving agencies have joined together to better respond to the mental health needs of children. 

One of the priorities of the Department of Mental Health’s Strategic Plan includes expansion of school-based mental health services. 

We invite your comments regarding how mental health services for children and youth might be improved in the state.  What factors should be considered in developing a comprehensive system for children?   How can schools and other community organizations serving children best coordinate with mental health professionals to respond to the needs of children?

— John Heskett, Ed.D., Director, Office of Comprehensive Child Mental Health

Hope

Hope is the thing with feathers — That perches in the soul — And sings the tune without the words — And never stops — at all. - Emily Dickenson

Those of us who are consumers know the importance of hope. Hope plays a factor in resilency, and it helps to keep us going during rough patches on the road to recovery.  The Department of Mental Health has been through some troubled times lately, but the changes I have seen since I assumed the role of Director of Consumer Safety last October have given me hope for a brighter future for consumers in Missouri.

I am heartened by the selection of Keith Schafer as the department's Director. He has developed stategies to address situations that have long required attention. He has included the consumer and family voice as in integral part of his visions, areas of emphasis, and stategies. His words are not just window dressing. He solicits opinions from and meets with consumers and families regularly. During my personal interactions with him, I have felt he listens to me and values what I have to say. I appreciate being treated as an equal.

As you may know the department received a Transformation Grant to help transform the current system to a decentralized one driven by consumers and their families. On July 10th and 11th the work groups presented their recommendations on how to achieve "Communities of Hope" to the Transformation Leadership Work Group. Beginning in August consumers across the state will have an opportunity to review the final recommendations and express their opinions regarding the process during open forums. I encourage you attend the gathering near your home so you may share your vision of a "Community of Hope."

– Leigh Gibson, Director, Office of Consumer Safety